早期消融房颤对长期结局的影响：GLORIA-AF 注册研究 II/III 期结果。
Impact of early ablation of atrial fibrillation on long-term outcomes: results from phase II/III of the GLORIA-AF registry.
机构信息
Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
出版信息
Clin Res Cardiol. 2022 Sep;111(9):1057-1068. doi: 10.1007/s00392-022-02022-1. Epub 2022 Apr 29.
BACKGROUND
First-line ablation for atrial fibrillation (AF) reduces the risk of recurrent atrial arrhythmias compared to medical therapy. However, the prognostic benefit of early AF ablation remains undetermined. Herein, we aimed to evaluate the effects of early AF ablation compared to medical therapy.
METHODS
Using data from phase II/III of the GLORIA-AF registry, we studied patients who were consecutively enrolled with newly diagnosed AF (< 3 months before baseline visit) and an increased risk of stroke (CHADS-VASc ≥ 1). At baseline visit, 445 (1.7%) patients were treated with early AF ablation and 25,518 (98.3%) with medical therapy. Outcomes of interest were the composite outcome of all-cause death, stroke and major bleeding, and pre-specified outcomes of all-cause death, cardiovascular (CV) death, non-CV death, stroke and major bleeding.
RESULTS
A total of 25,963 patients (11733 [45.2%] females; median age 71 [IQR 64-78] years; 17424 [67.1%] taking non-vitamin K antagonist oral anticoagulants [NOACs]) were included. Over a follow-up period of 3.0 (IQR 2.3-3.1) years, after adjustment for confounders, early AF ablation was associated with a significant reduction in the composite outcome of all-cause death, stroke and major bleeding (HR 0.50 [95% CI 0.30-0.85]) and all-cause death (HR 0.45 [95% CI 0.23-0.91]). There were no statistical differences between the groups in terms of CV death, non-CV death, stroke and major bleeding. Similar results were obtained in a propensity-score matched analysis of patients with comparable baseline variables.
CONCLUSIONS
Early AF ablation in a contemporary prospective cohort of AF patients who were predominantly treated with NOACs was associated with a survival advantage compared to medical therapy alone.
TRIAL REGISTRATION
Clinical trial registration: http://www.
CLINICALTRIALS
gov . Unique identifiers: NCT01468701, NCT01671007 and NCT01937377. Created with BioRender.com.
背景
与药物治疗相比，房颤（AF）的一线消融可降低复发性房性心律失常的风险。然而，早期房颤消融的预后获益仍不确定。在此，我们旨在评估与药物治疗相比，早期房颤消融的效果。
方法
使用 GLORIA-AF 注册研究 II/III 期的数据，我们研究了连续入组的新诊断房颤（基线就诊前 <3 个月）且卒中风险升高（CHADS-VASc≥1）的患者。在基线就诊时，445 例（1.7%）患者接受了早期房颤消融治疗，25518 例（98.3%）患者接受了药物治疗。主要终点为全因死亡、卒中和大出血的复合终点，以及全因死亡、心血管（CV）死亡、非 CV 死亡、卒中和大出血的预先指定结局。
结果
共纳入 25963 例患者（11733 例[45.2%]女性；中位年龄 71 岁[IQR 64-78]岁；17424 例[67.1%]服用非维生素 K 拮抗剂口服抗凝剂[NOACs]）。在 3.0（IQR 2.3-3.1）年的随访期间，调整混杂因素后，早期房颤消融与全因死亡、卒中和大出血的复合终点（HR 0.50 [95%CI 0.30-0.85]）和全因死亡（HR 0.45 [95%CI 0.23-0.91]）显著降低相关。两组在心血管死亡、非心血管死亡、卒中和大出血方面无统计学差异。在基线变量相似的倾向评分匹配分析中，也得到了类似的结果。
结论
在当前接受 NOAC 治疗的房颤患者的前瞻性队列中，早期房颤消融与单独药物治疗相比，具有生存优势。
临床试验注册
临床试验
NCT01468701、NCT01671007 和 NCT01937377。由 BioRender.com 创建。
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